According to the known treatment protocols HMG is given on day 2 of the menstruation cycle. A single or multiple dose of 0.25 mg to 5 mg of LHRH antagonist Cetrorelix was administered to prevent LH surges on day 5 until and including the day of ovulation induction with HCG. (Hum. Reprod. 1994 May; 9(5):788-91, Hum. Reprod. 1995 June; 10(6):1382-6, Fertil. Steril. 1997; 67:917-22, Hum. Reprod. 1998 September; 13(9)2411-4)
In the PCT application WO 98/58657 the LHRH antagonist ganirelix in an amount of 0.125-1 mg is administered in the method to prevent premature LH surges in women undergoing controlled ovarian hyperstimulation in combination with exogeneous FSH.
The EP 161 063 also teaches the use of a gonadotropin releasing hormone antagonist to prepare a pharmaceutical composition comprising a gonadotropin selected from HMG and FSH in the treatment of female infertility to suppress estrogen variability, in which treatment the antagonist composition is administered in an effective amount cojointly with the gonadotropin composition.
Usually for controlled induction of ovulation and final follicle maturation HCG (human chorionic gonadotropin) is given. 36 hours thereafter oocytes are picked up (OPU) by transvaginal or laparoscopic follicle puncture.
For the fertilisation of multiple oocytes by the sperms of the male partner assisted reproductive techniques (ART) are applied like IVF (in-vitro-fertilisation), ICSI (intracytoplasmic sperm injection), GIFT (gamete intra-Fallopian transfer) or ZIFT (zygote intra-Fallopian transfer) in highly specialized laboratories on the day of OPU.
Normally, two to four days after extracorporeal fertilization embryo transfer is performed by the replacement of several embryos into the cavum uteri to obtain pregnancy.
As many follicles develop following controlled ovarian stimulation therapy (COS) ovarian enlargement occurs and many oocytes are picked up. Therefore, oocyte pick up procedures have to be done in the operating theatre and with the application of general or regional anesthesia.
Assisted reproductive techniques are carried out in highly specialized laboratories by qualified personnel thereafter.
Preferably, these procedures have to be included into the routine operating theatre plans from Mondays to Fridays. The performance of oocyte pick up as well as of embryo transfer on weekends or holidays is avoided due to lack of enough qualified personnel on duty in most clinics. Furthermore, some hospitals undertake these procedures only on a few days each month in order to have the oocyte pick up and fertilization procedures performed by a highly specialized service team to increase the number of oocytes obtained as well as the fertilization rates and the number of good quality embryos. Therefore, programmed ovarian stimulation protocols are applied.